tion of feeling that I have helped many young men to their frail bark away from the apparently innocent outer circling waves of this maelstrom whose vortex has engulfed so many noble souls. There is not a gentleman on the floor of this Academy who uses alcoholics but would willingly-yes, gladly-abstain on any occasion if he could know that that particular indulgence would be the causative factor in the ruin of his own or my son. Gentlemen, the only absolute safety, especially for us, who are looked upon as the guardians of the health of the community, is total abstinence. The "Autocrat of the Breakfast Table" said: "The way to argue down a vice is not to tell lies about it, to say it has no attractions when everybody knows that it has, but rather to let it make out its own case, as it certainly will in the moment of temptation, and then meet it with the weapons furnished by the Divine Armory. In taking this position of total abstinence, as a physician I fully realize what I lose in the boon, good cheer, social ease and fellow ship among gentlemen, that comes from a moderate indulgence in alcoholics. There is certainly nothing which adds so much to the completion of the joys of a social hour as a moderate indulgence in the "cup that cheers." It blots out for the time differences, diffidences, jealousies; makes us forget our troubles, places us on an equality, in fact makes us what we naturally should beboon companions, full of good fellowship. Could I be persuaded that no harm would come to me or my family or my neighbor through my indulgence, I most assuredly would be a moderate drinker. The doctor also emphasizes the common observation that "the strongest, most intelligent, initiative, pushing, progressive, successful peoples on earth were the most liberal users of alcohol.' I do not accuse the doctor of intentionally using this statement in a sophistical manner, but he certainly would not think of even intimating to this audience that an individual's intelligence, energy, courage, comfort or success in life depended upon the amount of alcohol he consumed. As David Harum would say, "It was purty good jury truth but not gospel truth." The truth back of this statement is that the very fact of a nation's possessing these good qualities necessitates a very great wear and tear upon the energies of the people who are doing the work, many of whom, instead of paying heed to the physiological warning of tire and exhaustion, and recuperating their wasted energies by rest, sleep and wholesome food and drink, under a faulty education in regard to alcohol, weight down their safety-valves, as it were, by the anesthetic power of the drug, the danger of which every intelligent physician constantly recognizes. constantly recognizes. The result will oftentimes be not less disastrous than if the engineer should weight his safety-valve far beyond the point of danger, and then increase his fires under the boilers by using alcohol as a source of energy. Should he be so fortunate as to escape an explosion, he should have his license revoked as an incompetent and unsafe workman. We often hear it proclaimed that the brightest minds are found in habitual users of alcohol, as though its use were evidences of intellectual capacity. It cannot be denied that many men of high intelligence use them, and that many such use them intemperately, but I think if any observer of even ordinary intelligence and perception will fix his gaze just for a moment upon the whole class of drinkers, instead of on the occasional brilliant one, he would not have the temerity to again refer to the habit as particularly characteristic of a high order of intelligence. One of the best known editors in this country says that he selected twenty-four of the most eminent men in the world and found upon investigation that twenty were total abstainers and the other four moderate users. When we assume the responsibilities of the medical profession we become peculiarly the servants of the public in a most sacred relationship. We enter the home under condi. tions which often exclude the nearest friends, and become the depositories of secrets known to no others. We are in the very holy of holies, at times, that try men's souls; when the beloved one is in the most terrific agonies known to humanity, when a new being is being ushered into a new existence, when life trembles in the balance, when the last goodbyes are said, and the very heart-strings are being torn asunder. We are peculiarly related to humanity at its crises, and it is right and proper that the community should demand a high standard in the character of the medical profession who occupy this intimate association. Personal experience is so convincing that it is not easily overcome. "Seeing is believing." "Alas for the worth of human testimony," although not so old, is an expression which has been one of the obstacles that has interfered with the correct understanding of the true action of alcohol. When a person has studied the effects of this drug upon his own person, has felt the warm glow starting from his throat and stomach, and felt it gradually extend all over his body to his finger tips and to the very roots of his hair, even the most accurate thermometric observation to the contrary will often scarcely over-balance his fooled sensations, and convince him that no real increase in bodily temperature has taken place; if there were any increase at all, it was as the flash of gunpowder. To this observer, "feeling is believing." Instead of a real increase in temperature, what has really taken place? Through its effects upon the vasomotor nerves, the superficial blood-vessels are being filled with the warm internal blood, transmitting a sense of warmth to the more delicate nerves of sensation, so abundantly distributed to the skin. This warm blood is being more rapidly cooled by a nearer proximity to the cooler surrounding atmosphere. In a cold atmosphere alco. hol is a refrigerant, just in proportion as the air is colder than the body, explaining the common observation that most persons who have frozen to death have been under the influence of alcohol. A friend who was with a surveying party on the Canadian Pacific Railway told me that the Manitoba Indians have a saying like this: "If a man drink no fire-water, he wakes up well; if he drink a little he wakes up ill; if he drinks much, he wakes up dead. Brinton, in his lectures on medicine, gives an incident which is a good foundation for such a saying: "A party of engineers surveying in the Sierra Nevadas camped at a great height above the sea, where the air was very cold; some drank a little whisky and went to bed more comfortable, others drank a lot of whisky and went to bed very jolly. In the morning the men who had not drank got up in good condition; those who had drank a little felt miserable, and those who went to bed so jolly did not get up at all; they were frozen to death." When the student of this subject "takes a drop to keep him warm" and feels the first transient movement of thought, he is perfectly unconscious, so far as his sensations are concerned, that his powers of judgment, discretion and nice discernment are being proportionately paralyzed by the oncoming force of the drug's anesthetic power, as Kraepelin has so surely demonstrated, viz., "Alcohol makes more words, less thought. Helmholtz said that "in his own case, the smallest quantity of alcohol seemed to utterly dissipate brilliant or original thought." renowned literary writer of England gave as his own experience that "if he took wine with his dinner, even in moderation, he found that during the evening he could write with remarkable ease and satisfaction at the time; next morning he found that what had been so very satisfactory the evening before. would not at all satisfy the critical judgment of his unalcoholized brain." This blunting of the intellectual processes is most beautifully shown by the experiments of Professor Kraepelin with even smaller quantities of alcohol than Professor Atwater used in his experiments (two and a half to three ounces). Kraepelin's experiments extended over a period of twenty-seven days, and mental capacity was tested by problems in addition and memorizing. The test was first made for a few days without alcohol, with a daily increase in efficiency; the alcohol as then given for a few days, the mental capacity remaining about the same, then greatly and rapidly decreased, the decrease being more noticeable in the power to memorize. Stopping the alcohol, there was immediate increase of efficiency, which continued for seven days, then the alcohol was begun again, and immediately there was a great lessening of mental capacity." The investigator who has satisfied himself that alcoholics warm him when he is cold, make his ideas flow more easily when he is dull, is equally true that it strengthens him when he is weak. The "old brain fooler" does not miss a single fibre or function of the human body. The experiments of Professors Chittenden and Mendel, at Yale University, have often been quoted to prove that alcohol increases gastric juice, which it undoubtedly did in their experiments, but their experiments were made on dogs which were killed after digestion had gone to a certain stage, the control taking no alcohol. The contents of the stomachs were then analyzed with the above results, but Professor Chittenden adds: "Notwithstanding the apparent increase in gastric juice under alcohol, it is of no value to digestion, for in nearly every instance the presence of alcohol in the stomach has retarded digestion just in proportion to the alcohol used." Dr. W. H. Riley, of Boulder, Colol rado, in a very exhaustive paper, "The Effect of Alcohol on the Function and Structure of the Stomach," says that "if the experiments at Yale had been performed on the same dog repeatedly, emptying the stomach without killing the dogs, the fallacy of the supposed increase of gastric juice would have been readily detected." In Professors Chittenden and Mendel's experiments the irritant effect of the alcohol caused a more complete discharge of the gastric juice already stored up in the gastric glands. Dr. Riley says that where he had so frequently taken pains to carefully analyze the stomach's contents or even very moderate drinkers, he almost invariably found the gastric secretions were very much lessened. He also found as Chittenden and Mendel bad, that whether the experiments were made in the test-tube or in the stomachs of men or dogs, "digestion was almost invariably retarded just in proportion to the alcohol used; in a few cases, where 1 per cent or less was used, digestion seemed to be increased, but in more, even then, retarded. These observations are often met by the testimony of many patients who have taken alcoholics with very great relief of discomfort after eating, thus Paul's advice to Timothy has continued to be handed down, and there is no doubt that in many cases of painful digestion a great deal of temporary relief can be obtained from the anesthetic power of the drug, but these chronic dyspeptics, as a class, are the very people to whom it would be hazardous to administer alcoholics continuously. I wish that every member of this Academy would read and carefully consider a lecture by that eminent neurologist, Mr. Victor Horsley, delivered at St. James Hall, London, last April. He discussed the effects of aolohol upon the brain by the small doses of the moderate drinker, and in conclusion Mr. Horsley said that, from a scientific standpoint, he believes that he statements which have been made that small doses of alcohol such as people take at their meals, have practically no deleterious effect cannot be maintained. "The cumulative evidence on the subject shows that if we are to follow the plain teachings of truth and common sense we must be total abstainers." As to the use of alcohol in medicine, I have long felt that it has a very narrow field of usefulness, and that "therapeutics" would soon be immeasurably improved if we could erase from medical literature and from the medical mind every iota cf our knowledge of alcohol, and begin anew our investigations in a purely scientific manner. If the cause of alcohol in medicine were compelled to stand upon its real intrinsic merits, uninfluenced by appetite, prejudice and preconceived opinions, by social and commercial pressure, it would soon take its deserved place among the rarely used drugs. Many of the strong believers in alcohol as a medicine appear as under somewhat of a charm in their advocacy of their favorite remedy, and seem perfectly ignorant of the fact that there are many individuals with a congenital or acquired weakness to resist the drug habit power of this remedy. Our learned friend whom I quoted in the very beginning of this paper says: "I do not know of any disease condition amenable to medical treatment of any kind that may not be treated sucessfully without alcohol. This fact, however, would not prevent me from prescribing alcohol in any case that might, in my judg ment, be comforted thereby, without postponing or jeoparding, if not enhancing, recovery. "This comforting power is the real power of alcohol, and the very power that makes it so dangerous, as well as the explanation of its great appreciation by man all through the ages. The writings of Sir Benjamin Ward Richardson, in England, and Dr. N. S. Davis, Sr., in this country, ought to be sufficient alone, if well known, to cause every free prescriber of aclohol to pause and inquire whether he is an injury or a benefit to his patient. How often are our dearest memories of home and mother sorely shocked by what we are compelled to witness in the homes of the drinking poor. The bleared eyes, the soddence, the red nose of the alcoholized woman, surrounded by dirty, unkempt children, is the most sickening sight that I meet. It seems sacrilege to call these women mothers or these places homes. Many of these women will tell you, if you go to the trouble of getting their stories, that they began their habit by taking beer to increase their milk supply. Hard work, poor surroundings, frequent maternities are excessively wearing upon the lives of the poor, who have so few intervals of relaxation or recuperation. Many of them become both physically and mentally unfitted for their severe manual labor, to say nothing of total disqualification for that highest and most responsible duty of woman, motherhood! It is, as all know, the exception for these women to rear all-round, well-developed, successful children; thus these beer-drinking mothers become a real menace to the State. In the chronic condition of tire and ennui of these women, nothing so completely, quickly and delightfully removes all their ills as just the proper dose of an alcoholic. The headaches, and the backaches, the exhaustion, and all the heavy load of their overwhelming environments, that so depress them melt away as snow before the morning sun. The temporary relief is about as certain as if you should give the proper dose of morphine, immeasurably more pleasant and scarcely less dangerous in these women. Gentlemen before advising this seductive comforter to this very susceptible class, pause and take reckoning consider your responsibility, and do not let any personal relation to this question be a means of your damaging those who put their trust in you. There is one phase in the evolution of the alcohol question which will never be repeated, the prosecution of a physician for negligence or homicide in a fatal case of pneumonia, where the physician did not give alcoholics during the progress of the disease. This question was settled for all time by the decision in the case in which Dr. Hirschfeld, of Madgburg, Germany, was defendant. In this case Professor Binz, of Bonn; Prof. Struempel, of Erlangen; Prof. Harnack, of Halle with the Medical Council of Saxony, consisting of five physicians, made statements that were summarized as follows: "The idea that alcohol gives strength is deceptive; while any other form of alcohol may produce an apparent form of stimulation, there is always a reaction in a profoundly marked diminution of energy. The special action of alcohol on the brain and spinal cord is no longer a theory, but a fact which can be measured and proven. We are confident that experience will fully sustain our belief that no single human life which would have fallen a prey to death without aclohol has ever been saved by alcohol." years ago. Gentlemen, this was over twenty H. C. Wood long ago said that "perhaps many of the deaths which have been set down as due to chloroform and ether have been produced by the alcohol which was given for the relief of the patient." I believe that most of the teachers call attention to this danger, but if you will visit most of the operations performed in this city you will find whisky on the side table and should the patient get into a dangerous stage of anesthesia I fear he would run great risk of getting a few hypo dermics of it. Dr. Wood also calls attention to the danger of giving alcohol in shock where it used to be the "sheet anchor." Dr. Wood said: "It is of no use-indeed I am perfectly sure that a good dose of alcohol in a case of profound shock puts a nail in the coffin of the patient." I am glad that Cincinnati has the honor of claiming one of the poineers in correcting the mistaken ideas in regard to alcohol. In 1835 Dr. Reuben Mussey with Dr. Harvey Lindsley wrote a prize essay on alcohol in which occurs this sentence, at that time almost revolutionary: "I have no hesitancy in asserting that there is no state of the system, however exhausted or enfeebled; no species of malady, however obstinate or unyielding; no case of disease, however dangerous or appalling in which a substitute, perfectly equal to alcohol in all the exigencies of the case, may be found." Dr. N. S. Davis and his son, Dr. N. S. Davis, Jr., have reported 1,000 cases of typhoid fever treated in Mercy Hospital, Chicago, without alcohol, with a mortality of 5 per cent, while the statistics from other hospitals in this country at the same time ranged from 15 to 25 per cent. Dr. J. H. Kellogg and colleagues have treated during the last twenty years, 333 cases of typhoid fever without alcohol, with a mor tality of 2.7 per cent, and during the same time 82 cases of pneumonia with a mortality 4.9 per cent. Dr. Crothers, in looking over the reports of ten Eastern hospitals, found that the cost of alcoholics ranged from eleven to sixty-one cents per patient treated. It was certainly suggestive to find that the mortality was 8 per cent greater in the hospital using the sixty-one cents' worth. I do not know who was first to recommend acetic acid as a menstruum in the preparation of medicinal extracts, but I do know that Prof. R. Mussey was an ardent advocate of acetic acid preparations. Since so reputable a firm as E. R. Squibb & Sons produce a full line of the acetic acid preparations, at about one-half the cost of the alcoholic, I would think it wise for us to use the acetic extracts if for no other than economic rea Members of the Academy, if you wish to use alcoholics as a beverage, please remember that the more honorable, attractive and esteemed a moderate drinker may be, the more apt he is to lead young men into an indul gence that may prove their destruction. If you wish to use it as a food, do not forget that many as well qualified men as any in the profession agree with Prof. Hodge, of Clark University, whose extensive experiments forced him to the conclusion that "alcohol retards, perverts and is destructive. in either large or small doses, to normal cell growth and development." If you wish to use it as a diffusible stimulant and generator of force, in low forms of disease, remember that many high in the estimation of their brethren, whose honesty and ability are above question, and whose motives are irreproachable, declare that they have had better results without them. Members of the Academy, in preparing this paper I have treated the subject in a frank and impolitic manner, setting forth my honest convictions without fear or favor, and I feel satisfied that I have produced enough evidence to convince any unprejudiced mind that total abstinence is the only attitude I can recommend to my son, who says he is going to study medicine, and also that alcohol as a medicine is at least of very doubtful efficacy and utility in the very conditions where it was formerly most prized by the medical profession.-Lancet-Clinic. FOR membranous enteritis, an emulsion of castor oil and salol, continued for a considerable period, is often useful in this troublesome condition. THE MEDICAL FORTNIGHTLY Issued Tenth and Twenty-Fifth of Every Month. THOMAS A. HOPKINS, Editorial Staff: O. E. LADEMANN, Internal Medicine. JOHN MCHALE DEAN, Surgery. F. P. NORBURY, Nervous and Mental Diseases. R. B. H. GRADWOHL. Pathology and Bacteriology. WALDEMAR FISCHER, Ophthalmology. A. LEVY, Pediatrics. W. T. HIRSCHI, Therapeutics. A. F. KOETTER, Otology. HERMAN STOLTE, Laryngology and Rhinology. Editorial Rooms, Suite 319-321 Century Building, St. Louis. Expert Testimony. EDITORIAL APROPOS to a recently developed phase of the Patrick case an editorial appeared in the Post-Dispatch which is worthy of reproduction, as it emphasizes that the lay mind is coming to view this question in the same light as has been voiced by Dr. Gradwohl in these columns repeatedly. It also emphasizes the fact that even a great daily is not keeping itself informed on what is doing in our own Health Department along this line, and we take pleasure in reproducing with the editorial a letter to the paper from Chief Dispensary Physician Scherck, prompted by the editorial and dealing with local aspects of the subject, which should be the property of the general public, but espe cially of the medical profession. The editor of the Post-Dispatch says: "A petition signed by 3500 physicians has been forwarded to Gov. Higgins, of New York, in behalf of Alfred T. Patrick, the lawyer now under sentence of death for murder. Only four requests to sign were refused out of the thousands sent out. "With the signatures came letters from 250 prominent physicians, in which a marked feature was the contempt expressed by many writers for expert testimony rendered for pay by one side or the other in criminal cases. "The protest of the New York physicians against expert testimony for pay which has assumed the dimensions and character of a scandal should suggest to lawyers the expediency of a reform. "The guilt or innocence of any particular defendant is not here in question. But it is remarkable that whenever one side offers an eminent expert as a witness the other is ready with one equally eminent and equally cocksure. The notion that such testimony is helpful to a jury is grotesque. The juryman is asked to choose between two conflicting infallibilities. As a matter of fact, he invokes a plague on both of them and decides the case as best he can on the other evidence produced. "Justice must and ought to rely upon science, especially in criminal cases. It would be illogical and absurdly devoted to the good old ways to refuse to hear what science has to say. But science is one thing, the retained, well-feed scientist is another. The one enlightens, the other darkens and confuses. "Expert testimony should be tendered in the interest of truth, not in the interest of prosecution or defense. If some means can be found by legislation to obtain good scientific expert testimony unbiased and unfeed, it will be a great advance. Cannot the State employ experts to investigate and report facts and deductions, charging the expense to the public treasury? That would tend to discredit paid-for testimony and enable the jury to get the benefit of real and honest rather than warped and partisan opinion.” Dr. Scherck's reply was as follows: To the Editor of the Post-Dispatch: An editorial under the caption "Expert Testimony," which appeared in your paper columns of September 21st, 1906, has suggested the idea that a communication from me to the effect that a distinct advance in the matter of expert testimony has been in operation in this city for more than a year, for which the Health Department of St. Louis can claim credit, and since the spirit which actuates the commission is in strict accordance with the ideas expressed in your very valuable editorial, I have deemed it of sufficient importance to request that you give this letter publicity. There exists an informal Commission on Insanity to examine all cases of supposed insanity which occur among the criminal classes who are under arrest and charged with crime. The chief purposes underlying the organization of this commission were a cultivation of a better undertsanding of expert testimony in respect to mental questions in the Criminal Court of St. Louis; and second, the training of a group of experts in such questions for service in the courts and the collection of such data as afterwards might prove of value in respect to the problems that arise in the relation of the criminal to nervous and mental diseases. The most common plea in extenuation of criminal acts of major importance is insanity, and to establish this defence it is the custom |